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General NPI Number Information
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NPI Number | 1982882957
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Entity Type | Organization
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Legal Business Name | MAURICE CONVERSE
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 6253 W WYANDOTTE RD
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City | MAUMEE
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State | OH
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Zip | 43537-1336
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Country | US
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Telephone | 419-865-4464
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Fax |
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Provider Business Mailing Address
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Address Line | 6253 W WYANDOTTE RD
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City | MAUMEE
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State | OH
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Zip | 43537-1336
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Country | US
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Telephone | 419-865-4464
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Fax |
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Authorized Official
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Title or Position | SENIOR CLIENT REP
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Name | DEIRDRE ANN HARDY
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Credential |
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Telephone | 419-380-0116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 35020368C
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License Number State | OH
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